This article is going to be very concise and to the point. Concussion is serious injury and is called a mild traumatic brain injury (mtbi) and can lead to death if not managed correctly.

What is concussion?

Concussion is a sudden traumatic event to the head or body which can cause a single symptom or a number of symptoms that are associated to brain function. (See table 1). It does not have to be a direct blow but can be caused by acceleration and deceleration forces without the head actually being hit.

  • Acute symptoms represent functional disturbances; this means that actions might be affected (loss of balance, dizziness, headaches, concentration etc.) Rather than structural changes.
  • Symptoms occur quickly but normally resolve on their own.
  • Brain scans are usually normal. This doesn’t mean the child isn’t concussed though.

 There are many myths that surround concussion:concussion1

  1. Loss of consciousness is not always required for someone to have a concussion
  2. Concussion can’t be diagnosed on an x-ray, CT-scan or MRI.
  3. Mouth guards have been shown not to make a difference in concussion.
  4. Head gear will help with facial cuts but have no effect on preventing concussion

Signs and symptoms of concussion

  • Headache
  • Dizziness
  • Nausea
  • Ringing in the ears
  • Sleep disturbances
  • Drowsiness
  • Fatigue
  • Sadness
  • Sensitivity to light
  • Sensitivity to noise
  • Blurred vision or partial loss of vision
  • Confusion & disorientation
  • Delayed reaction & response times
  • Slow or slurred speech
  • Vomiting
  • Diminished playing ability
  • Poor concentration
  • Poor performance in class
  • Irritability
  • Emotional changes, depression



concussion2Why is concussion so dangerous?

If a concussion occurs before a previous concussion has totally cleared it causes a condition caused a secondary impact syndrome.  This causes the brain to swell and causes pressure on the brain stem. It is therefore very important to allow all concussions to clear before returning to any exercise. In adolescents this condition is fatal in 90% of the cases.

How do we know if someone has a concussion?

The most important rule in concussion is,”if in doubt sit them out”. There are basic test that can be done in order to diagnose concussion. There is often immediate loss of memory so we ask the following 5 questions-      1. Where are we playing?

  1. Which half is it?
  2. What is the score?
  3. Which team did we play last week?
  4. Did we win last week?

This combined with balance tests will give you an indication of whether the player is concussed.


If they are a SCAT3 is administered.  This is a more in-depth test. It gets administered immediately, 2, 4, 8, 12, 24, 48 and 72 hours after.


concussion3A doctor MUST assess you if there is a suspected concussion. If the concussion is severe you might be admitted to hospital to monitor the signs and symptoms of concussion. If not you will be sent home and you must stay under the supervision of a responsible person.

You need to avoid: drinking alcohol, taking excessive pain killers, watching TV, listening to music or doing any computer or mental work. Remember your brain is injured. You wouldn’t go sprint with a torn hamstring so don’t use your brain too much either when it’s injured.

If the symptoms progressively get worse, you start having fits or the headache progressively becomes worse you MUST get to the hospital as soon as possible.



Most cases of concussion will clear on their own with sufficient rest. This means that the individual needs to stay away from any stimulus that might over-stimulate the brain. Avoid TV, music reading etc and ensure there is enough sleep.


Return to play?

A grade recovery process is used when return to play is initiated. The individual needs to be totally symptom free before they start any activity. If they have completed a pre-season neuropsychological test these parameters must return to normal levels

A progressive exercise rehabilitation protocol is used

  1. Light aerobic exercise is used (walking or stationary cycling) if there are no symptoms this can be progressed to jogging the next day
  2. Sport specific exercises (functional running exercises and progressive non contact ball handling skills)
  3. Non contact exercises
  4. Full contact training
  5. Game play

At all times there must be no symptoms. If symptoms are present regress back to the level where there were no symptoms and return to the level again if there is still no symptoms for 48 hours.

It is always better to be over cautious with concussion as it can have long lasting cognitive effects if not managed correctly. For further information please look at the following website

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David Milner - M. Phil (Physio) UCT

David qualified at Wits in 1998 in Physiotherapy. He then went on to also complete his BSc in Physiology in 1999. He started working at Hacks Back sports rehabilitation Practise where he was for 2 years and also joined Kaizer Chiefs soccer in 1999. He has completed his MPhil in Sports Physiotherapy at the University of Cape Town and is currently on the Medical committee of the Professional Soccer League

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